Skin Cancer xxix, 2011 : Page 42

LIFESTYLE The Glaring Need for Sun Safety in Schools JEFF ASHLEY, MD I magine having a child stricken with xeroderma pigmentosum, a genetic disease causing extreme suscepti-bility to sun-induced skin cancer. Now imagine being told by the child’s school that wearing a sun-protective hat on school grounds is forbidden, even with a doctor’s note. Sadly, this has happened. The reaction in California was to pass legislation giving all children the right to protect themselves with a hat, long clothing, and sunscreen while outdoors at school. 1 You might think that would have solved the problem. Indeed, some schools embraced the new law. However, many appar-ently chose to ignore it or remained unaware of it. Research has shown that children typically experience signiﬁcant sun exposure during a school day, often enough to cause sunburn, and even more often, enough to cause DNA damage that increases their risk of skin cancer over the course of their school years. 2 In states without school sun safety legislation, or in schools lacking a sun safety policy regard-less of state law, we owe it to our children to advocate for improved protection. This can begin at an individual school or with an appeal to the school district’s elected board members or trustees. The question is, just how do you go about doing it? APPROACHING YOUR SCHOOL One starting point is to meet with the principal and ask her or him to establish a sun safety committee within the school administration. However, it might be more effective to raise the issue at a meeting of your school’s Parent Teacher Association (PTA) and propose that a sun safety committee be formed within the PTA. Many schools also have a tax-exempt booster organization afﬁliated with the PTA. This group might provide greater ﬁnancial ﬂexibility and stability with fundraising for sun safety projects. You can ask a dermatologist, pe-diatrician, or the school nurse to assist you at any pivotal meetings to make your case for sun safety. MOBILIZING A SUN SAFETY COMMITTEE meet certain architectural criteria and be installed by union labor. This can cost well in excess of $20,000 for a modest 30 x 30 ft. structure. However, other sun safety strategies are far less expensive and might be even more ef-fective, such as promoting hats and long clothing, encouraging sunscreen use, and supporting classroom sun safety instruction, as well as in-service education for staff and communication with parents. In states without school sun safety legislation, or in schools lacking a sun safety policy regardless of state law, we owe it to our children to advocate for improved protection. The crucial ﬁrst step for a sun safety committee is strategic planning — iden-tifying and ranking goals, then deciding how to al-locate the funds you raise. The big-ticket item will probably be shade struc-tures. Shade is certainly desirable, but in California, for instance, permanent shade structures must 42 S K I N CA N C E R F O UND A T I O N J O URN A L

The Glaring Need For Sun Safety In Schools

Jeff Ashley, MD

Imagine having a child stricken with xeroderma pigmentosum, a genetic disease causing extreme susceptibility to sun-induced skin cancer. Now imagine being told by the child’s school that wearing a sun-protective hat on school grounds is forbidden, even with a doctor’s note. Sadly, this has happened.

The reaction in California was to pass legislation giving all children the right to protect themselves with a hat, long clothing, and sunscreen while outdoors at school.1 You might think that would have solved the problem. Indeed, some schools embraced the new law. However, many apparently chose to ignore it or remained unaware of it.

Research has shown that children typically experience significant sun exposure during a school day, often enough to cause sunburn, and even more often, enough to cause DNA damage that increases their risk of skin cancer over the course of their school years.2 In states without school sun safety legislation, or in schools lacking a sun safety policy regardless of state law, we owe it to our children to advocate for improved protection. This can begin at an individual school or with an appeal to the school district’s elected board members or trustees. The question is, just how do you go about doing it?

APPROACHING YOUR SCHOOL
One starting point is to meet with the principal and ask her or him to establish a sun safety committee within the school administration. However, it might be more effective to raise the issue at a meeting of your school’s Parent Teacher Association (PTA) and propose that a sun safety committee be formed within the PTA. Many schools also have a tax-exempt booster organization affiliated with the PTA. This group might provide greater financial flexibility and stability with fundraising for sun safety projects. You can ask a dermatologist, pediatrician, or the school nurse to assist you at any pivotal meetings to make your case for sun safety.

MOBILIZING A SUN SAFETY COMMITTEE
The crucial first step for a sun safety committee is strategic planning – identifying and ranking goals, then deciding how to allocate the funds you raise. The big-ticket item will probably be shade structures. Shade is certainly desirable, but in California, for instance, permanent shade structures must meet certain architectural criteria and be installed by union labor. This can cost well in excess of $20,000 for a modest 30 x 30 ft. structure. However, other sun safety strategies are far less expensive and might be even more effective, such as promoting hats and long clothing, encouraging sunscreen use, and supporting classroom sun safety instruction, as well as in-service education for staff and communication with parents.

APPROACHING THE BOARD OF ED
To bring the issue to the attention of a school district’s board of education, you might work with school administrators or officials to add a sun safety policy draft to the formal agenda of a board meeting. However, this route can be elusive, especially if the superintendent is unenthusiastic.

Fortunately, most districts also allow "public comment" at board meetings. Before the meeting begins, members of the public typically request an opportunity to speak. If possible, enlist a local dermatologist to address the board, and distribute a prepared handout. If the appeal is successful, the board might direct the superintendent to present a policy proposal at a future meeting. This could open the door for you to work with the superintendent on a policy. (Experience gained from our research with school districts has been summarized in a how-to manual.3)

A recent study4 that our team authored investigated the adoption of sun safety policy by school boards. We worked with the California School Boards Association (CSBA) to draft a policy5 that addressed the following issues:

Because this sample policy was vetted by CSBA’s attorneys, school board members were more comfortable with it compared to a similar pre-existing sample policy from an unfamiliar entity. The CSBA also issued a Policy Brief 6 to detail the elements of the sample policy and encourage its acceptance.

Adopting a comprehensive policy like the one developed by CSBA is ideal, but one way or another, every district should be asked to remove any existing policy barriers to sun protection.

EDUCATING STUDENTS – AND STAFF
Children will be more inclined to practice sun protection if they understand why it’s important, namely to prevent skin cancer and premature aging. We certainly don’t want to inhibit kids from getting exercise outdoors, so they need to learn ways to block the sun, not the fun. However, to make an impression on teens might require exposing them to graphic examples of skin cancer and the surgery needed to treat it.

Sun safety should be integrated into the curriculum at every grade level, and classroom instruction can be reinforced through posters, staff-initiated reminders, assemblies conducted by dermatologists or pediatricians, and the screening of sun safety videos. To encourage teachers, coaches, and other school staff to model and teach sun-protective behaviors, ask the district nurse to provide an in-service education.

HATS AND SUNSCREENS: TROUBLESHOOTING COMMON CONCERNS
Schools may ban hats because of concerns about them being used to signify gang affiliation. However, a school could develop a policy allowing students to wear a particular style or color of hat. Be sure to include students in selecting the permitted hat style(s), so that they feel part of the process and don’t end up embarrassed to wear the style(s) selected. Incorporate a sun-protective hat into the school’s line of "spirit wear" and offer rewards for wearing it. If children refuse to wear a broad-brimmed or legionnaire-style hat, a baseball cap is better than no hat at all. Teen girls often refuse to wear hats because of the impact on their hair. They could benefit from being allowed to wear a broad-brimmed visor.

Because the FDA considers sunscreens over-the-counter drugs, schools commonly defer to their "zero tolerance" policy to refrain from promoting sunscreen use. In such cases the district must amend its policy, exempting sunscreens from such bans. School officials sometimes raise the fear of sunscreen allergy, not knowing it is uncommon and of minor impact. Point out that it is about as harmful as an allergic reaction to the hand soap in the school’s bathrooms: No one would ban soap. In fact, in Australia, pump bottles of sunscreen are commonly provided in classrooms. That may be wishful thinking here, but sunscreen should be among the items every child should bring to school and be encouraged to use.

THE TIME FOR SCHOOL SUN SAFETY IS NOW
With skin cancer incidence jumping from one million cases a year to 3.5 million a year in the latest measurements, the need for sun safety policy and education in schools is more urgent than ever. The time to learn about and start practicing sun protection is in youth, when safety behaviors can be established for a lifetime. It takes only one parent, educator, doctor or nurse to initiate school-based change that will truly make a difference. That champion could be you.

DR. ASHLEY is a Clinical Professor of Dermatology at the Keck School of Medicine, University of Southern California. He practices dermatology in Burbank, CA. Dr. Ashley is the president of Sun Safety for Kids, which is among the organizations (including The Skin Cancer Foundation) that comprise the National Council on Skin Cancer Prevention. Contact: dr.ashley@sunsafetyforkids.org.

THE SKIN CANCER FOUNDATION’S SUN SAFETY EDUCATIONAL PROGRAMS FOR SCHOOLCHILDREN
The Skin Cancer Foundation has been the leader in educating schoolchildren about sun safety and skin cancer prevention since the 1980s, with publications ranging from "Flash!" to "The Sun Day News" to "Play It Safe in the Sun." The American Academy of Dermatology recently awarded the Foundation its prestigious annual Gold Triangle award for our ongoing program combining classroom instruction with online activities. Teachers around the country use our activities and curriculum, which align with National Health Education Standards and National Science Education Standards. For more information, please visit www.SkinCancer.org.